Smokers and risk of hospital death by COVID calculated with SAVANA's natural language processing in the Castilla-La Mancha area.

INTRODUCTION: During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and Natural Language Processing (NLP) technology is used. METHOD: A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla La Mancha using Natural Language Processing and Artificial Intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021. RESULTS: Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (p < 0.0001).Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (p < 0.0001). CONCLUSION: There is an increased risk of dying in hospital in SARS-COV2-infected patients who are active smokers or have smoked in the past.

Prediction of sports talent in young throwers using machine learning / Predicción del talento deportivo en jóvenes lanzadores utilizando machine learning

The objective of this study is to detect any performance factors in athletics throws between 1997 and 2015 in 662 throwers (15.67 ± 1.01 years of the National Program for Sports Technification of the Royal Spanish Athletics Federation using Machine Learning methods by means of algorithms (Logistic Regression, Random Forest and XG Boost). When examining the importance of the variables with reference to performance, the triple jump (0.20) stands out over the rest of the variables: backward overhead shot throw (0.14), arm span (0.11), vertical jump (0.10), body mass (0.20), height (0.07) and flexibility (0.03). In each discipline the triple jump takes the lead in shot put (0.20), discus (0.21) and hammer (0.29) throws, while backward overhead shot throw does in javelin, the variables rearranging themselves in a particular way depending on the discipline. These findings enable the early detection of potential talents as well as their subsequent sport specialization (AU)

El estudio aborda la detección de factores de rendimiento en los lanzamientos atléticos utilizando técnicas de Machine Learning, en 662 lanzadores (15,67 ± 1,01 años) del Programa Nacional de Tecnificación Deportiva de la Real Federación Española de Atletismo entre 1997 y 2015, mediante diferentes algoritmos (Logistic Regression, Random Forest y XGBoost). Al medir la importancia de las variables en función del rendimiento, el triple salto (0,20) destaca sobre el resto de variables: lanzamiento dorsal (0,14), envergadura (0,11), salto vertical (0,10), masa corporal, estatura (0,07) y flexibilidad (0,03). En cada disciplina, el triple salto encabeza la importancia en los lanzamientos de peso (0,20), disco (0,21) y martillo (0,29), mientras que el lanzamiento dorsal lo hace en la jabalina (0,20). Las variables se reordenande forma particular modificando su importancia para cada disciplina. Estos hallazgos permiten mejorar la detección inicial de posibles talentos, así como su posterior especialización deportiva (AU)

Patient-reported outcomes in RA patients treated with tofacitinib or bDMARDs in real-life conditions in two Latin American countries / Desenlaces reportados por los pacientes diagnosticados con AR tratados con tofacitinib o FARME biológico bajo condiciones reales en dos países de Latinoamérica

Objective: To describe efficacy, safety, and patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA) with an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) treated with tofacitinib or biological DMARDs (bDMARDs) in real-life conditions. Methods: A noninterventional study was performed between March 2017 and September 2019 at 13 sites in Colombia and Peru. Outcomes measured at baseline and at the 6-month follow-up were disease activity (RAPID3 [Routine Assessment of Patients Index Data] score), functional status (HAQ-DI [Health Assessment Questionnaire] score), and quality of life (EQ-5D-3L [EuroQol Questionnaire]). The Disease Activity Score-28 (DAS28-ESR) and frequency of adverse events (AEs) were also reported. Unadjusted and adjusted differences from baseline were estimated and expressed as the least squares mean difference (LSMD). Results: Data from 100 patients treated with tofacitinib and 70 patients with bDMARDs were collected. At baseline, the patients’ mean age was 53.53 years (SD 13.77), the mean disease duration was 6.31 years (SD 7.01). The change from baseline at month 6 was not statistically significant different in the adjusted LSMD [SD] for tofacitinib vs. bDMARDs for RAPID3 score (−2.55[.30] vs. −2.52[.26]), HAQ-DI score (−.56[.07] vs. −.50[.08]), EQ-5D-3L score (.39[.04] vs. .37[.04]) and DAS28-ESR (−2.37[.22] vs. −2.77[.20]). Patients from both groups presented similar proportions of nonserious and serious AEs. No deaths were reported.Conclusion: Changes from baseline were not statistically significantly different between tofacitinib and bDMARDs in terms of RAPID3 scores and secondary outcomes. Patients from both groups presented similar proportions of nonserious and serious AEs.(AU)

Objetivo: Describir la eficacia, la seguridad y los desenlaces reportados por los pacientes (PRO) en pacientes con artritis reumatoide (RA) con una respuesta inadecuada a los fármacos antirreumáticos modificadores de la enfermedad sintéticos convencionales (csFARME) tratados con tofacitinib o FARME biológico (bFARME) en condiciones de la vida real. Métodos: Estudio no intervencional realizado entre marzo de 2017 y septiembre de 2019 en 13 centros de Colombia y Perú. Los desenlaces evaluados al inicio y a los seis meses de seguimiento fueron la actividad de la enfermedad (puntaje Routine Assessment of Patients Index Data [RAPID3]), el estado funcional (puntaje Health Assessment Questionnaire [HAQ-DI]) y la calidad de vida (EuroQol Questionnaire [EQ-5D-3L]). El puntaje de actividad de la enfermedad-28 (DAS28-ESR) y la frecuencia de eventos adversos (EA). Se estimaron las diferencias no ajustadas y ajustadas con respecto a los valores basales y se expresaron como diferencia de medias por mínimos cuadrados (LMD). Resultados: Se recolectó información de 100 pacientes tratados con tofacitinib y 70 pacientes con bFARME. Al inicio del estudio, la edad media de los pacientes era de 53,53 años (DE 13,77) y la duración media de la enfermedad de 6,31 años (DE 7,01). El cambio con respecto al valor basal en el mes 6 no fue estadísticamente significativo en la LMD ajustada (SE) para tofacitinib vs. los bFARME para RAPID3 (−2,55 [0,30] vs. −2,52 [0,26]), puntuación HAQ-DI (−0,56 [0,07] vs. −0,50 [0,08]), puntuación EQ-5D-3L (0,39 [0,04] vs. 0,37 [0,04]) y DAS28-ESR (−2,37 [0,22] vs. −2,77 [0,20]). Los pacientes de ambos grupos presentaron proporciones similares de EA no graves y graves. Ninguna muerte fue reportada. Conclusiones: Los cambios desde el inicio no fueron estadísticamente significativos entre tofacitinib y los bFARME en RAPID3 y en los desenlaces secundarios. Los pacientes de ambos grupos presentaron proporciones similares de EA no graves y graves.(AU)

Patient-reported outcomes in RA patients treated with tofacitinib or bDMARDs in real-life conditions in two Latin American countries.

OBJECTIVE: To describe efficacy, safety, and patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA) with an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) treated with tofacitinib or biological DMARDs (bDMARDs) in real-life conditions. METHODS: A noninterventional study was performed between March 2017 and September 2019 at 13 sites in Colombia and Peru. Outcomes measured at baseline and at the 6-month follow-up were disease activity (RAPID3 [Routine Assessment of Patients Index Data] score), functional status (HAQ-DI [Health Assessment Questionnaire] score), and quality of life (EQ-5D-3L [EuroQol Questionnaire]). The Disease Activity Score-28 (DAS28-ESR) and frequency of adverse events (AEs) were also reported. Unadjusted and adjusted differences from baseline were estimated and expressed as the least squares mean difference (LSMD). RESULTS: Data from 100 patients treated with tofacitinib and 70 patients with bDMARDs were collected. At baseline, the patients' mean age was 53.53 years (SD 13.77), the mean disease duration was 6.31 years (SD 7.01). The change from baseline at month 6 was not statistically significant different in the adjusted LSMD [SD] for tofacitinib vs. bDMARDs for RAPID3 score (-2.55[.30] vs. -2.52[.26]), HAQ-DI score (-.56[.07] vs. -.50[.08]), EQ-5D-3L score (.39[.04] vs. .37[.04]) and DAS28-ESR (-2.37[.22] vs. -2.77[.20]). Patients from both groups presented similar proportions of nonserious and serious AEs. No deaths were reported. CONCLUSION: Changes from baseline were not statistically significantly different between tofacitinib and bDMARDs in terms of RAPID3 scores and secondary outcomes. Patients from both groups presented similar proportions of nonserious and serious AEs. CLINICAL TRIAL NUMBER: NCT03073109.

Floral colour variation of Nicotiana glauca in native and non-native ranges: Testing the role of pollinators' perception and abiotic factors.

Invasive plants displaying disparate pollination environments and abiotic conditions in native and non-native ranges provide ideal systems to test the role of different ecological factors driving flower colour variation. We quantified corolla reflectance of the ornithophilous South American Nicotiana glauca in native populations, where plants are pollinated by hummingbirds, and in populations from two invaded regions: South Africa, where plants are pollinated by sunbirds, and the Balearic island of Mallorca, where plants reproduce by selfing. Using visual modelling we examined how corolla reflectance could be perceived by floral visitors present in each region. Through Mantel tests we assessed a possible association between flower colour and different abiotic factors. Corolla reflectance variation (mainly along medium to long wavelengths, i.e. human green-yellow to red colours) was greater among studied regions than within them. Flower colour was more similar between South America and South Africa, which share birds as pollinators. Within invaded regions, corolla reflectance variation was lower in South Africa, where populations could not be distinguished from each other by sunbirds, than in Spain, where populations could be distinguished from each other by their occasional visitors. Differences in corolla colour among populations were partially associated with differences in temperature. Our findings suggest that shifts in flower colour of N. glauca across native and invaded ranges could be shaped by changes in both pollination environment and climatic factors. This is the first study on plant invasions considering visual perception of different pollinators and abiotic drivers of flower colour variation.

Systemic Corticosteroids in Patients With Bronchial Asthma: A Real-Life Study

Objective: The objective of the present study was to determine the use of systemic corticosteroids (SCs) in patients with bronchial asthma using big data analysis. Methods: We performed an observational, retrospective, noninterventional study based on secondary data captured from free text in the electronic health records. This study was performed based on data from the regional health service of Castille-La Mancha (SESCAM), Spain. We performed the analysis using big data and artificial intelligence via Savana® Manager version 3.0. Results: During the study period, 103 667 patients were diagnosed with and treated for asthma at different care levels. The search was restricted to patients aged 10 to 90 years (mean age, 43.5 [95%CI, 43.4-43.7] years). Of these, 59.8% were women. SCs were taken for treatment of asthma by 58 745 patients t some point during the study period. These patients were older, with a higher prevalence of hypertension, dyslipidemia, diabetes, obesity, depression, and hiatus hernia. SCs are used frequently in the general population with asthma (31.4% in 2015 and 39.6% in 2019). SCs were prescribed mainly in primary care (59%), allergy (13%), and pulmonology (20%). The frequency of prescription of SCs had a direct impact on the main associated adverse effects. Conclusion: In clinical practice, SCs are frequently prescribed to patients with asthma, especially in primary care. Use of SCs is associated with a greater number of adverse events. It is necessary to implement measures to reduce prescription of SCs to patients with asthma, especially in primary care (AU)

Objetivo: El objetivo del presente estudio fue determinar el uso de corticoides sistémicos (CS) en pacientes con asma bronquial mediante el análisis de big data. Métodos: Se realizó un estudio observacional, retrospectivo y no intervencionista basado en datos secundarios capturados a partir de texto libre en las historias clínicas electrónicas. Este estudio se realizó a partir de los datos del Servicio Regional de Salud de Castilla-La Mancha (SESCAM), España. Se realizó el análisis mediante big data e inteligencia artificial a través de Savana® Manager versión 3.0. Resultados: Durante el periodo de estudio, 103 667 pacientes fueron diagnosticados y tratados de asma en los diferentes niveles asistenciales. La búsqueda se restringió a pacientes de entre 10 y 90 años (edad media, 43,5 [IC 95%, 43,4-43,7] años). De ellos, el 59,8% eran mujeres. 58 745 pacientes tomaron SC para el tratamiento del asma en algún momento del periodo de estudio. Estos pacientes eran de mayor edad, con una mayor prevalencia de hipertensión, dislipidemia, diabetes, obesidad, depresión y hernia de hiato. Los SC se utilizan con frecuencia en la población general con asma (31,4% en 2015 y 39,6% en 2019). Los SC se prescribieron principalmente en Atención Primaria (59%), Alergia (13%) y Neumología (20%). La frecuencia de prescripción de SCs tuvo un impacto directo en los principales efectos adversos asociados. Conclusiones: En la práctica clínica, los CS se prescriben con frecuencia a los pacientes con asma, especialmente en Atención Primaria. El uso de los CS se asocia a un mayor número de efectos adversos. Es necesario implementar medidas para reducir la prescripción de CS a los pacientes con asma, especialmente en Atención Primaria (AU)

Motivos de derivación y características epidemiológicas de los pacientes atendidos en una consulta monográfica de dermatoscopia de un hospital terciario español / Reasons for Referral and Epidemiological Characteristics of Patients Seen at a Dedicated Dermoscopy Unit in a Spanish Tertiary Care Hospital

Las consultas monográficas de dermatoscopia digital están dirigidas a la población con alto riesgo de melanoma. Conocer los motivos de derivación a estas consultas, así como las características epidemiológicas de los pacientes permite optimizar los recursos sanitarios, y determinar qué pacientes se benefician más de esta técnica. Se analizaron los motivos de derivación y las características epidemiológicas de 413 pacientes atendidos en una consulta monográfica de dermatoscopia en un período de 10 años, y que presentaban al menos un criterio de alto riesgo de melanoma. También se analizó el número necesario de extirpaciones (NNE) por cada melanoma diagnosticado, sus características histológicas y las variables no ambientales se asociaron con su diagnóstico. Los motivos de derivación más frecuentes fueron: antecedentes de melanoma previo (21,5%), cambios detectados por el paciente o su familia (20%), hallazgos clínicos y/o dermatoscópicos sospechosos de malignidad (19,4%) y antecedentes familiares de melanoma (17,4%). Setenta y seis de las 178 lesiones extirpadas fueron melanomas, obteniendo un NNE de 2,34. La edad avanzada fue el único factor de riesgo que se asoció de forma estadísticamente significativa con el desarrollo de melanoma (AU)

Dedicated dermoscopy units assess individuals at high risk for melanoma. Understanding the reasons for referral to these units and the epidemiological profile of referred patients can help optimize health care resources and determine who benefits most from dermoscopic evaluation. We analyzed reasons for referral and epidemiological characteristics of 413 patients with at least 1 high-risk factor for melanoma seen at a dedicated dermoscopy unit over a period of 10 years. We also analyzed the number of necessary excisions (NNE) for each melanoma diagnosed, histologic features, and associations between nonenvironmental factors and diagnosis. The main reasons for referral were a past history of melanoma (21.5%), changes detected by the patient or a relative (20%), clinical and/or dermoscopic findings suggestive of malignancy (19.4%), and a family history of melanoma (17.4%). Seventy-six of the 178 excised lesions were melanomas (NNE per melanoma detected, 2.34). Older age was the only risk factor significantly associated with the development of melanoma (AU)

[Translated article] Reasons for Referral and Epidemiological Characteristics of Patients Seen at a Dedicated Dermoscopy Unit in a Spanish Tertiary Care Hospital / Motivos de derivación y características epidemiológicas de los pacientes atendidos en una consulta monográfica de dermatoscopia de un hospital terciario español

Dedicated dermoscopy units assess individuals at high risk for melanoma. Understanding the reasons for referral to these units and the epidemiological profile of referred patients can help optimize health care resources and determine who benefits most from dermoscopic evaluation. We analyzed reasons for referral and epidemiological characteristics of 413 patients with at least 1 high-risk factor for melanoma seen at a dedicated dermoscopy unit over a period of 10 years. We also analyzed the number of necessary excisions (NNE) for each melanoma diagnosed, histologic features, and associations between nonenvironmental factors and diagnosis. The main reasons for referral were a past history of melanoma (21.5%), changes detected by the patient or a relative (20%), clinical and/or dermoscopic findings suggestive of malignancy (19.4%), and a family history of melanoma (17.4%). Seventy-six of the 178 excised lesions were melanomas (NNE per melanoma detected, 2.34). Older age was the only risk factor significantly associated with the development of melanoma (AU)

Las consultas monográficas de dermatoscopia digital están dirigidas a la población con alto riesgo de melanoma. Conocer los motivos de derivación a estas consultas, así como las características epidemiológicas de los pacientes permite optimizar los recursos sanitarios, y determinar qué pacientes se benefician más de esta técnica. Se analizaron los motivos de derivación y las características epidemiológicas de 413 pacientes atendidos en una consulta monográfica de dermatoscopia en un período de 10 años, y que presentaban al menos un criterio de alto riesgo de melanoma. También se analizó el número necesario de extirpaciones (NNE) por cada melanoma diagnosticado, sus características histológicas y las variables no ambientales se asociaron con su diagnóstico. Los motivos de derivación más frecuentes fueron: antecedentes de melanoma previo (21,5%), cambios detectados por el paciente o su familia (20%), hallazgos clínicos y/o dermatoscópicos sospechosos de malignidad (19,4%) y antecedentes familiares de melanoma (17,4%). Setenta y seis de las 178 lesiones extirpadas fueron melanomas, obteniendo un NNE de 2,34. La edad avanzada fue el único factor de riesgo que se asoció de forma estadísticamente significativa con el desarrollo de melanoma (AU)

N-acetylcysteine as a therapeutic approach to post-COVID-19 pulmonary fibrosis adjunctive treatment.

OBJECTIVE: Growing interest is directed to the outcomes of COVID-19 in survivors, both in the convalescent period and in the long-term, which are responsible for morbidity and quality of life deterioration. This article aims to describe the mechanisms supporting the possible use of NAC as an adjuvant treatment for post-COVID-19 pulmonary fibrosis. MATERIALS AND METHODS: A search was performed in PubMed/MEDLINE. RESULTS: Interstitial changes have been observed in the CT scan of COVID-19 pneumonia. In patients with respiratory outcomes in the post-COVID-19 stage, glutathione (GSH) deficiency was found and interpreted as a reaction to the inflammatory cascade caused by the viral infection, while the pathophysiological process of pulmonary fibrosis involves numerous cytokines, such as TGF-ß, TNF-α, IL-1, PDGF and VEGF. NAC has a good tolerability profile, is easily administered orally and inexpensively, and has antioxidant and anti-inflammatory effects that may target the pathophysiologic mechanisms involved in pulmonary fibrosis. It may revert GSH deficiency, exerts direct and indirect antioxidant activity, anti-inflammatory activity and improves immune T-cell response. CONCLUSIONS: The mechanism of action of NAC suggests a role in the treatment of pulmonary fibrosis induced by COVID-19.

Reasons for Referral and Epidemiological Characteristics of Patients Seen at a Dedicated Dermoscopy Unit in a Spanish Tertiary Care Hospital. / Motivos de derivación y características epidemiológicas de los pacientes atendidos en una consulta monográfica de dermatoscopia de un hospital terciario español.

Dedicated dermoscopy units assess individuals at high risk for melanoma. Understanding the reasons for referral to these units and the epidemiological profile of referred patients can help optimize health care resources and determine who benefits most from dermoscopic evaluation. We analyzed reasons for referral and epidemiological characteristics of 413 patients with at least 1 high-risk factor for melanoma seen at a dedicated dermoscopy unit over a period of 10 years. We also analyzed the number of necessary excisions (NNE) for each melanoma diagnosed, histologic features, and associations between nonenvironmental factors and diagnosis. The main reasons for referral were a past history of melanoma (21.5%), changes detected by the patient or a relative (20%), clinical and/or dermoscopic findings suggestive of malignancy (19.4%), and a family history of melanoma (17.4%). Seventy-six of the 178 excised lesions were melanomas (NNE per melanoma detected, 2.34). Older age was the only risk factor significantly associated with the development of melanoma.

Work productivity in rheumatoid arthritis patients from two Latin American countries treated with tofacitinib or biological DMARDs.

OBJECTIVE: To evaluate work productivity of adult Latin American patients with rheumatoid arthritis (RA) treated with tofacitinib and biological disease-modifying anti-rheumatic drugs (bDMARDs) measured by the Work Productivity and Activity Impairment (WPAI) in RA questionnaire at 0- and 6-month follow-up. METHODS: This non-interventional study was performed in Colombia and Peru. Evaluated the effects of tofacitinib and bDMARDs in patients with RA after failure of conventional DMARDs. The WPAI-RA questionnaire was administered at baseline and at the 6-month (±1 month) follow-up. The results are expressed as least squares means (LSMs), and standard errors (SEs). RESULTS: One hundred patients treated with tofacitinib and 70 patients treated with bDMARDs were recruited. Twenty-eight percent of patients from the tofacitinib group and 40.0% from the bDMARDs group were working for pay at baseline. At month 6, the changes in absenteeism, presenteeism, and work impairment due to health were -18.3% (SE 7.7), -34.8% (SE 5.9), and -11.0% (SE 16.5), respectively, in the tofacitinib group and -19.4% (SE 8.0), -34.8% (SE 6.2), and -15.9% (SE 15.0), for the bDMARD group. CONCLUSION: For patients who reported working, there were improvements in presenteeism, absenteeism, and work impairment due to health in both groups. TRIAL REGISTRATION: NCT03073109.

'Rainbow pattern': a dermoscopic sign of invasive melanoma.

BACKGROUND: The 'rainbow pattern' was initially described as a highly specific dermoscopic feature of Kaposi sarcoma. Since then, it has been reported in many benign and malignant cutaneous tumours, including a few malignant melanomas (MMs). AIM: To determine the frequency and presentation of this dermoscopic pattern in primary cutaneous MMs in comparison to other cutaneous tumours. METHODS: The presence of a rainbow pattern was evaluated in a sample of 1100 dermoscopic images of different melanocytic and nonmelanocytic cutaneous neoplasms. RESULTS: The rainbow pattern was observed in 23 of 245 (9.4%) MM and 44 of 855 (5.1%) non-MM neoplasms. MMs presenting this feature were generally thicker: 82.6% > 1 mm and 43.0% > 2 mm. Compared with non-MMs, rainbow pattern in MMs was more commonly focal (82.7% vs. 36.4% nonfocal, P = 0.001) and associated with > 2 dermoscopic structures associated with MM (100% vs. 9% with fewer, P = 0.001). CONCLUSION: The rainbow pattern is a dermoscopic sign that can occasionally be observed in invasive MMs. In MMs, this feature is usually associated with other dermoscopic criteria of MM and located in a focal and eccentric area, as opposed to a diffuse and isolated presentation in non-MM neoplasms.

Systemic Corticosteroids in Patients with Bronchial Asthma: A Real-Life Study.

OBJECTIVES: The objective of the present study was to determine the use of systemic corti-costeroids (SCs) in patients with bronchial asthma using big data analysis. METHODS: We performed an observational, retrospective, noninterventional study based on secondary data captured from free text in the electronic health records. This study was per-formed based on data from the regional health service of Castille-La Mancha (SESCAM), Spain. We performed the analysis using big data and artificial intelligence via Savana® Manager version 3.0. RESULTS: During the study period, 103 667 patients were diagnosed with and treated for asthma at different care levels. The search was restricted to patients aged 10 to 90 years (mean age, 43.5 [95%CI, 43.4-43.7] years). Of these, 59.8% were women. SCs were taken for treatment of asthma by 58 745 patients at some point during the study period. These patients were older, with a higher prevalence of hypertension, dyslipidemia, diabetes, ob-esity, depression, and hiatus hernia. SCs are used frequently in the general population with asthma (31.4% in 2015 and 39.6% in 2019). SCs were prescribed mainly in primary care (59%), allergy (13%) and pulmonology (20%). The frequency of prescription of SCs had a direct impact on the main associated adverse effects. CONCLUSION: In clinical practice, SCs are frequently prescribed to patients with asthma, especially in primary care. Use of SCs is associated with a greater number of adverse events. It is necessary to implement measures to reduce prescription of SCs to patients with asthma, especially in primary care.

Relación entre consumo de alcohol, uso de Internet y teléfono móvil, sintomatología prefrontal y mindfulnes disposicional en estudiantes universitarios / Alcohol use in relation to Internet and mobile phone use, prefrontal symptomology and dispositional mindfulness in university students

and mobile phone use, prefrontal symptomology and dispositional mindfulness in university students. This study analyzes the relationship between the type of alcohol use and parameters associated with addictive behaviors, such as abnormal use of the Internet and mobile devices, prefrontal symptoms and dispositional mindfulness in 509 university students from Madrid (Spain). The present study was multivariate, inferential, descriptive and nonexperimental, using discriminant analysis to study the predictive nature of the variables considered in weekend alcohol use, with participants classified into three groups (low, medium and high use). The results indicate that high alcohol use was related to greater Internet and mobile phone use, greater irritability and under executive control, as well as a lower mindfulness level. Longitudinal studies are needed to analyze, among other aspects, the mediating role of dispositional mindfulness in alcohol use, use of technologies and executive functioning (AU)

Uso de perifiton en un sistema de policultivo en agro acuicultura integrada en la comunidad indígena de Jimaín, Sierra Nevada de Santa Marta (Colombia) / Periphyton-based polyculture in an integrated agri-aquaculture system at the indigenous community of Jimaín, Sierra Nevada de Santa Marta (Colombia)

RESUMEN Los Sistemas de Agro Acuicultura Integrada (SAAI) han sido estudiados como opción para la producción de pescado en comunidades con recursos limitados. Así mismo, el uso de perifiton se ha convertido recientemente en una alternativa viable por el aporte de alimento natural de bajo costo. El objetivo de este estudio fue evaluar el efecto del perifiton sobre el desempeño productivo del policultivo Piaractus sp. (cachama híbrida) y Prochilodus magdalenae (bocachico) en SAAI en la comunidad Indígena de Jimaín, Colombia. Se sembraron 1,5 alevinos de cachama híbrida y 1,5 bocachicos/m2, con peso promedio de 0,49 ± 0,14 g y 1,83 ±1,61 g respectivamente, en seis estaques en tierra de 90 m2 tres de los cuales contaron con varas de madera (3 varas/m2) para la fijación de perifiton. La duración del cultivo fue de 135 días. Los tratamientos (CS: con sustrato y SS: sin sustratos) recibieron una dieta suplementaria dos veces al día, calculada como porcentaje de la biomasa con ajuste quincenal. Se realizaron biometrías quincenales. Los datos productivos por especie y para el policultivo se evaluaron mediante ANOVA con un modelo lineal general (p < 0,05). Los datos de peso (g) y longitud estándar (cm) por especie se evaluaron mediante un modelo mixto de medidas repetidas. No se encontraron efectos del sustrato sobre los parámetros productivos analizados tanto para cada especie, como para el policultivo. Se presentó interacción significativa para el peso del bocachico el día 90 (CS: 74,7 y SS: 47,1). Según los resultados obtenidos, la utilización de perifiton y el manejo en policultivo de especies nativas requiere más estudios.

ABSTRACT Integrated agri-aquaculture systems (IAAS) have been studied as an option for fish production in communities with limited resources. Likewise, the use of periphyton has recently become a viable alternative for its contribution of low-cost natural food. The effect of periphyton use on the productive yield of a hybrid cachama and bocachico polyculture in IAAS, was studied in the Jimaín Indigenous community, Colombia. For this experiment, 1.5 hybrid cachama and 1.5 bocachico fingerlings/m2 were stocked with average weights of 0.49 ± 0.14 g and 1.83 ± 1.61 g, respectively, in six 90 m2 land ponds; three of these ponds had wooden dowels (three dowels/m2) for periphyton fixation. The growth evaluation lasted 135 days. The treatments (WS: with substrate and WOS: without substrates) received a supplementary diet, adjusted as a percentage of the biomass with biweekly adjustment, twice a day. Biometrics were performed every two weeks. The productive data by species and for the polyculture were evaluated using an ANOVA with a general linear model (p <0.05). Weight (g) and standard length (cm) data by species were evaluated using a mixed model of repeated measures. No substrate effects were found on the productive parameters analyzed for each species as well as for the polyculture. A significant interaction was observed for bocachico weight on day 90 (WS: 74.7 and WOS: 47.1). According to the obtained results, optimizing the use of periphyton and the management of native species polyculture requires further studies.

Cutaneous Head and Neck Melanoma: Changes in Clinical and Histologic Features From 1995 to 2015 in a Tertiary Hospital in Madrid, Spain. / Melanoma cutáneo de cabeza y cuello: evolución de las características clínico-patológicas en un hospital terciario de Madrid (1995-2015).

OBJECTIVES: Few epidemiological studies have analyzed cutaneous head and neck melanoma (CHNM) in the Spanish population. The aim of this study was to describe the clinical and histologic features of a representative sample of CHNM in Spain and to analyze changes observed over a period of 21 years. MATERIAL AND METHODS: Descriptive, retrospective, cross-sectional study of 280 patients diagnosed with CHNM at Hospital General Universitario Gregorio Marañón in Madrid, Spain, between January 1, 1995, and December 31, 2015. The main clinical and histologic features were analyzed and compared between 3 periods: 1995-2001, 2002-2008, and 2009-2015. RESULTS: Mean age at diagnosis was 71.3 years (median, 74 years; interquartile range [IQR], 65-81 years). The most common location was the face, followed by the scalp. The main histologic subtype was lentigo maligna (n=172, 64%). Mean tumor thickness was 1.6 mm (median, 0.4mm; IQR, 0-2.1mm). Median follow-up was 111 months; in this time 51 patients experienced CHNM recurrence (18.2%) and 29 died of the disease (10.4%). In the years analyzed, we observed a significant increase in the number and percentage of patients aged 75 years or older (P=.001) and in the percentage of melanomas in situ (P=.003). We also observed a significant decrease in mean tumor thickness (P=.018), the number of cases with 6 or more mitotic figures (P=.013), the percentage of patients with metastasis (P=.014), and melanoma-specific mortality (P=.005). CONCLUSIONS: CHNM affects elderly patients and is preferentially located on the face. The predominant subtype is lentigo maligna. Patients presented with thinner tumors over time and are now less likely to develop metastasis and to die of melanoma.

Prognostic significance of sentinel node biopsy status in cutaneous melanoma: a 21-years prospective study from a single institution.

AIM: To analyze the accuracy of the sentinel lymphatic node biopsy (SLNB) and to investigate predictive factors for sentinel node (SN) status and prognostic factors for recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with melanoma. MATERIAL AND METHODS: Between June 1997 and June 2017, 440 consecutive patients, who underwent SLNB by a single surgical team, were prospectively included. Descriptive and survival analysis were performed. RESULTS: 119 of 440 patients (26%) had positive SN. SLNB's false-negative rate was 6.3%. Breslow thickness, Clark´s level, ulceration and histological subtype were statistically significant predictive factors of SN metastases. In a multivariate analysis, positive SN (HR = 2.21, p = 0.01), deeper Breslow thickness (HR = 2.05, p = 0.013), male gender (RR = 2.05, p = 0.02), and higher Clark's level (HR = 2.30, p = 0.043) were significantly associated with decreased RFS; and positive SN (HR = 2.58, p < 0.001), deeper Breslow thickness (HR = 2.57, p = 0.006) and male gender (HR = 1.93, p = 0.006) were associated with lower DSS. CONCLUSION: SLNB is a reliable and reproducible procedure with high sensitivity (93.7%). Positive SN metastases, Breslow thickness and male gender were statistically associated with poorer outcomes. Male gender was an independent prognostic factor of tumor thickness or SN status.